Immunotherapy in non-metastatic urothelial cancer: back to the 'future'

Area of Science:

• Oncology
• Immunology
• Urology

Background:

• Metastatic urothelial cancer treatments have seen success with immunotherapy, prompting investigation into non-metastatic settings.
• Current treatments for non-metastatic urothelial cancer are limited, toxic, and have shown no significant improvement for over two decades.
• Alternatives to intravesical bacillus Calmette-Guérin (BCG) and mitomycin C failure in non-muscle invasive bladder cancer are scarce, often leading to cystectomy.
• Neoadjuvant cisplatin-based chemotherapy offers minimal benefits for disease recurrence and metastasis in urothelial cancer, accompanied by significant toxicity.

Purpose of the Study:

• To review the emerging role of immunotherapy in the treatment of non-metastatic urothelial cancer.
• To provide an overview of current developments and future directions for immunotherapy in this patient population.

Main Methods:

• Review of preliminary studies and ongoing clinical trials investigating immunotherapy in non-metastatic urothelial cancer.
• Analysis of existing literature on conventional treatment modalities and their limitations.

Main Results:

• Preliminary studies indicate promising results for immunotherapy in local and loco-regional urothelial cancer.
• Immunotherapy is emerging as a potential key player in the evolving treatment landscape for non-metastatic urothelial cancer.

Conclusions:

• Immunotherapy is poised to play a significant role in the future treatment of non-metastatic urothelial cancer.
• Large comparative trials are underway to establish practice-changing evidence and potentially shift the treatment paradigm.